目的:分析肾上腺皮质腺癌(adrenocortical carcinoma, ACC)的CT、MRI表现特点，并探讨二者诊断ACC的价值。方法:回顾分析经手术及病理检查证实的39例ACC患者的CT、MRI平扫及增强检查表现及临床资料，总结对ACC有较大诊断价值的影像学征象，比较2种成像技术在ACC诊断中的价值。结果:14例患者同时完成了CT和MRI平扫加增强检查，22例患者仅接受了CT平扫加增强检查，3例患者仅接受了MRI检查。39例ACC患者中，38例肿瘤为单侧发病(左侧19例、右侧19例)，1例为双侧发病；23例肿瘤呈分叶状,16例呈类圆形；肿瘤直径为4.0~17.3 cm。CT、MRI检查中，分别有47.2%、82.4%的病例病灶内存在出血灶；91.7%、50%的病例发现肿瘤内增粗、迂曲的肿瘤血管影；77.8%、82.4%的病例提示包膜不光整。所有肿瘤均呈不均匀强化，肿瘤实性成分多呈中度增强；少量病例可见钙化、周围脏器血管受累、腹膜后淋巴结及远处肿瘤转移。14例同时完成CT和MRI平扫加增强检查的病例中，2种成像技术分别发现肿瘤灶内出血6例、12例，肿瘤内增生血管12例、6例，包膜不光整9例、12例。结论:ACC的CT、MRI表现具有一定特征性，多表现为体积较大（直径多大于4 cm），病灶呈分叶状，内多见肿瘤血管、出血坏死，肿瘤累及包膜；增强后多呈中度不均匀强化。CT在检出肿瘤血管影方面具有一定优势，而MRI在显示肿瘤内出血方面具有一定优势。

Objective: To analyze CT and MRI imaging features of adrenocortical carcinoma (ACC). Methods: A retrospective analysis was conducted on the CT, MRI plain and contrast-enhanced imaging manifestations and clinical data of 39 ACC patients,and all were confirmed by surgery and pathological examination. The imaging features with significant diagnostic value for ACC were summarized, and the value of two imaging techniques for the diagnosis of ACC was explored. Results: Fourteen patients underwent both CT and MRI plain and enhanced examinations, while 22 patients underwent CT plain and enhanced examinations, and 3 patients underwent MRI examination only. Among the 39 ACC patients, 38 tumors were unilateral (19 on the left and 19 on the right), and 1 tumor was bilateral; twenty-three cases of tumors were lobulated, while 16 cases were quasi circular; the diameter of the tumor ranged from 4.0 to 17.3 cm. In CT and MRI examinations, intralesional hemorrhage was found in 47.2% and 82.4% of cases; thickened and tortuous tumor vasculature were found in 91.7% and 50% of cases; irregular capsule was found in 77.8% and 82.4% of cases. All tumors showed heterogeneous enhancement, and most of the solid components of the tumor showed moderate enhancement; a small number of cases showed calcification, involvement of surrounding organs and blood vessels, retroperitoneal lymph nodes, and distant metastasis. Among the 14 cases who completed both CT and MRI plain and enhanced examinations, 6 and 12 cases with hemorrhage of tumor, 12 and 6 cases with tumor vasculature, and 9 and 12 cases with capsule irregularities, were found respectively. Conclusions: The manifestations of CT and MRI have certain characteristics in ACC patients. Most ACCs tend to be large (diameter more than 4 cm), lobulated, and tumor vasculature, with areas of hemorrhage and necrosis, capsule irregularities, and heterogeneous enhancement. CT has advantages in evaluating tumor vasculature over MRI, while MRI has advantages in displaying intralesional hemorrhage over CT.